In the aftermath of September 11, the United States' ability to effectively detect, confront and combat the use of biological agents such as plague, smallpox, anthrax and ebola as weapons of mass destruction has become the focus of well-founded government and public concern. Recent cases of anthrax confirm the threat's reality. As summarized in the New York Times series on Bio-Terrorism: “This intentional release of potentially lethal viruses or bacteria into the air, food or water supply—poses a daunting technical challenge to our public health infrastructure.”
A bio-terrorist event may be detected when increasing numbers of people with similar symptoms seek treatment in hospital emergency departments, physician's offices, or clinics over a period of several hours, days, or weeks. But early clinical symptoms of infection for most bio-terrorism agents may be similar to common diseases seen by health care professionals every day. Early detection of these agents is paramount as only a narrow window of time is available for successful treatment and prophylaxis; otherwise mortality is high. Until ubiquitous biosensors are instituted, our most effective defense is early warning of an attack identified by index cases afflicted by a specific agent. Still, early detection may be the only solution if radically altered strains or new agents are deployed rendering agent specific biosensors or immunizations useless. Unfortunately, many of our public and private health care systems are ill prepared to assess whether the patient's symptoms are typical of an endemic disease (influenza, for example) currently circulating in the community or related to a natural or purposeful outbreak.
In California, the State's Department of Health Services (CDHS) is tasked to work with public health agencies in establishing the capacity to determine the etiology and source of an outbreak and to identify the most effective and efficient interventions that can protect public safety. CDHS faces a daunting challenge in coordinating an enormous cast of organizations and services associated with the identification, prevention, treatment and management of public health epidemics; these include the State's Office of Emergency Services (OES) and the Emergency Medical Services Authority (EMSA). Working with these two agencies directly or on the periphery are also the local health departments, emergency management organizations, facilities and supplies, physicians, surgeons, veterinarians, registered nurses, school nurses, infection control practitioners, medical examiners and many others. This challenge of interagency collaboration and coordination is amplified when considering the problem at a national level.
At all levels—federal, state and local—the National Electronic Disease Surveillance System (NEDSS), the Centers for Disease Control and Prevention (CDC), the Department of Health Services (DHS) and the multitude of other groups, systems and organizations necessarily involved share some common issues, including:                Limited coordination and communication because of a lack of real time reporting structures and technology bridging affected agencies (e.g., the CDC, FBI, CIA, NSC, DOD, DOT, DOE, DOA, FENA, National Guard, FEMA, Justice Department, etc);        Major breakdowns in the collection, collation, communication and comprehension of relevant data from hospitals, clinics, physician offices, schools, agriculture departments, slaughterhouses, and other disease portals in our communities;        A deficit of directed public health officer information required to enhance the ability to detect and report suspicious syndromes;        Limitation of experience working in collaborative groupware environments, supporting standards and promoting efficient, effective and timely intervention by all agencies; and        A lack of integrated user interfaces that enhance visualization of large and often complex datasets to help officials rapidly recognize real threats and respond accordingly.        
Bringing everyone together to reduce the incidence of transmission of infectious agents will depend on how rapidly early victims can be triaged, diagnosed, isolated when necessary, and treated. Early communication with local health departments will be essential in controlling or preventing, not only disease transmission, but also in the provision of public reassurance. How quickly local and state health departments can respond to the crisis will depend on how rapidly they are notified of a possible outbreak.
There is therefore a pressing need for both early warning systems to detect potential attacks on public health and safety and a means to organize and coordinate resources effectively and efficiently across diverse communities and populations.
For instance, it would be desirable to solve issues with:
Health care organizations that are not set up to share information, but instead gather, analyze and store information with the intention to be used only by their creators and in a reflective mode only.
The prevalence of different data types and schemes that hamper real time analysis and generate costs to aggregate, access and assess.
Ad hoc coordination that make post-event interventions difficult, expensive and potentially delayed.
The latest anthrax events have brought to our attention the weakness in our ability to gather and exchange information within our public health, safety and security institutions. Most of these systems gather information in a non-standard manner and process it with proprietary systems that are used primarily to perform historical analysis. This results in little aggregation of data that could be used to indicate and predict illness and deaths due to a possible bio-attack. In this particular example, without the ability to share information, collaboration by various agencies in response to a bio-threat is severely hampered. For instance, information about patients entering the health system is gathered in a single-user manner and not shared outside the immediate health care delivery system involved.
Once information becomes available in real-time and is complemented by data from other venues, real-time analysis and prediction can be performed. In a bio-induced emergency, quick access to information is of the essence as well as the ability to predict how the hazard may spread. Timely information allows administrators to quickly and exactly contain hazards and effects.
Data is worth very little if it is not understood by those who need to access to it. Since many different disciplines will need to work together to advance our surveillance capabilities, we need to insure that the many different views of information, and how to interact with that information, are addressed. The health care industry is still using old paradigms of information display and interaction. Static text or simple graphics, with no interaction possible and no link to more sophisticated sets of information, will only continue to hamper any efforts in bio-surveillance. It would therefore be desirable to provide an advanced visualization system that will take into account several needs that are impediments to cognition and collaboration.
It would also be desirable to provide a system that will display information in a format that is most useful to the viewer. This will allow users to adapt to the system quickly with minimum training. Although there will be different ways to view information, everyone will have access to the same timely information. It would further be desirable to provide a system that will communicate a significant amount of information into a small area of computer monitor display real estate by application of innovative data presentation techniques. Time is always a limiting factor for professionals and improving their access to information and the amount per unit time are keys to improved surveillance, detection, analysis, responsiveness and overall resource management.